Making the sandwich work

It would be very nice if everyone had excellent health from the day they are born until the day they die.

It would be very nice if people could do things for themselves their whole life, and never need any help.

It would be nice if the very young and very old were self sufficient and able to support themselves.

It would be very nice. But that's not the way it works in this world of illness, incapacity and age. The truth is that for the very young and for the very old, life is not easy.

And therefore sometimes, because of that, life is not easy for those caught in the middle.

Today, sick children have a high rate of survival and the average elderly person lives well into their 70's and often well beyond that.

Meanwhile families in the last 40 years have become smaller. That means that the children of seniors generally have fewer kids to take care of, but they also have fewer siblings to help care for elderly parents who may become ill or incapacitated.

There are millions of middle aged adults today caught in what is called the "sandwich generation." This is the group of people (the Pew Research Center estimates that 10 million families are in this boat), who, for the first time in history, have to deal with an ever expanding group of older people who are living longer, but also find that their children's children are almost becoming their own as well.

Today, about three million families in the United States have grandparents raising grandchildren. It is not uncommon to see someone in their 40's or 50's with a couple of grandkids trailing along behind them at the grocery store; and it isn't just for a day out with grandma.

"In this situation you never really get to be grandma," said Terry Willis of Price who is presently in custody of and is raising two of her grandkids, Keyea who is four and Sammi who is seven. "I am now the one that has to make them do things. I can't spoil them like a grandma should."

On the other side, these same middle aged adults are also caring for, or at least worrying a great deal about their own parents who are in their 70's and 80's.

While families did this kind of thing in previous generations too, the strains today are different. Most middle aged adults have careers; either on their own or in conjunction with a spouse. To pay the bills many people both work. In days past women stayed home more and could take the time to care for everyone in the family.

What has changed too is the sharing of responsibilities. The old adage says that a shared burden is a much easier burden to carry, and the more people that share the load, the simpler it is. In the days before 1940 most families were large and the many could help out. Since 1950 families have reduced a great deal in size, so middle aged people today have fewer siblings from which to seek support.

For some grandparents, they may have their kid's kids living with them, but their parents might also be very healthy and capable of taking care of themselves.

"My mother is 78 and she was supposed to go take care of my great aunt in Florida last winter after she fell," said Willis. "But my mother fell and broke her wrist. If I hadn't been tied up with the grandchildren I would have been the one to take care of my aunt. Ultimately my mother had surgery on her wrist and flew to Florida anyway to take care of Aunt Gladys who is now 98."

Terry Willis' granddaughter Sammi points to where she made her last shot as she, her sister Keyea, and Willis play a game of horse in their driveway. Willis says that when the grandkids came to stay, life got much more complicated.

Willis worries about the day her mother may need care and she is bound by taking care of grandchildren.

And that is the core of the problem. At some point the inevitable will and the elderly will need at least some assistance.

Most children of elderly parents want their parents to be able to stay in their home for as long as possible. The situation can even be more tentative if only a single parent remains alive or if the two parents are not together and each must have separate care.

Before that happens potential caregivers need to do an inventory on what can be done in such a situation. Here are some ideas on how to plan for that day.

There is a profession called a geriatric care manager. According to the National Association of Geriatric Care Managers, PGCM's are health and human services specialists who help families care for older relatives, while encouraging as much independence as possible. PGCM's may be trained in any but not limited to, nursing, gerontology, social work, or psychology, with a specialized focus on issues related to aging and elder care. The PGCM acts as a guide and advocate - identifying problems and offering solutions.

Look at the people available to help out and what their skills may be to do that. A union of people is stronger than one, particularly if they have varying degrees of skill to use. Siblings and close friends of parents, even people from the parent's church may be able to help out, at least in the short run. It is a good thing to do this before the need arises.

While skills each sibling or friend has may be helpful, remember the biggest problem in taking care of ailing parents is time. What commitments does each person have and what can they give to the care when needed. Someone who is raising two or three grandchildren may not be the one that can care for elderly parents. Those siblings that are married may already have a commitment to take care of their spouses parents who are sick. Of all the jobs one needs to do for an elderly parent, day to day care is the biggest by far. Who, or what group of people are going to do that? Is the parent going to continue to live at home or move in with one of the children? Or will the children share that care responsibility by having the parent move from home to home?

Plan for all kinds of scenarios. Hope for the best, but then the worst could happen too. Look at what it will take for a parent to stay in their home even though they may be ill. The reason for beforehand planning is to get the parents opinion on what they want to have done. Most of course would want to stay in their home, but in talking with them a child can bring up the situations in which that may not be possible. If the children and the elderly parent can come to some kind of agreement beforehand, it is always better than after an illness has struck.

This is also a good time to know about plans they have made. Do they have a will and/or a living will. How are they doing financially and have they made any plans for in case they become incapacitated. What insurances do they have in supplement to medicaid and or some type of pension insurance? If they have no supplemental insurance, it might be a good idea to get some because stay in such places as care facilities can quickly wipe out even seemingly large bank accounts.

Just try to avoid any surprises at the time a problem should occur.

When a major or life threatening event does occur, it is good thing to have the power to do everything that needs to be done. Parents should have a durable power of attorney so that one of the children can make financial decisions and pay bills on their behalf. This same power should be granted to making health care decisions.

Figure out what you need to do for yourself. Taking care of elderly parents or grandkids or both can be stressful, much more so than that first family you raised when you were in your 20's and 30's.

"I wouldn't want it any other way," says Willis. "I wouldn't want my grandchildren with anyone else. But it has placed a lot of limitations on our life."

Willis points out that when she quit her regular job, she was planning to advance her artist career further. However, the situation with the grandchildren began about six months before she quit and she could see the writing on the wall.

"I had to put my art career on hold, particularly the marketing and travel that I needed to do," she said. "We planned for me to quit to do that for five years and then in only a short time it all changed."

She says that being responsible for taking care of other human beings middle age has made it so she can't travel with her husband on business like they had planned and that the yearly ski trip they take each winter creates a lot of problems too.

"We can either find someone to take care of them or we can take them along," she stated. "However, if we take them along the school doesn't like that too much."

She said she and her husband even had been waiting for seven years for a special permit to travel the Grand Canyon, but that they can't take the grandkids with them.

"We could be using that this fall, but we will have to give that up," she said.

Elderly and sick parents are in some ways tougher to deal with when it comes to the impact on life. Grandkids at least go to school, while a live in parent is there all the time.

The point is that caregivers can be worn down and out too. They can get sick because of the constant demands and stresses on their lives. And even if a parent has financial means, sometimes financial strains of missing out on work and extra costs can lead to problems.

One local woman, whose mother lives in another part of the state, had to travel back and forth to help her mom through cancer treatments recently. While she was sharing the responsibility of doing so with her sister and brother, she still had to stay at her mother's home for a week at a time five or six times in the last year."

"I used to have a lot of vacation and sick leave, but I used most of that up right at the beginning of the illness," she said.

Then she had to go on family medical leave for some of the time and didn't get paid for it.

"I ended up with smaller paychecks for a while now, I don't have any vacation left either. I used to go with my husband on business trips once in a while, but now, even though I have accumulated a few days, I don't dare because what if something else happens or I get sick and need time off. That could devastate us financially."